Why so many lipid panels?

Doesn't cholesterol naturally ebb and flow?  Or does it only ebb and flow when we feed it?

For my taste the second panel is better, other than the HDL.  I'd say she did a good job getting her Cholesterol up over the holidays....

One of the highlighted lines in my Taubes book is the piece about the lower the cholesterol the higher the incidence of cancer.  Correlation I know but wasnt all the science about cholesterol a well choreographed dance around correlation.

My father was a cancer patient and a heart patient.  He "naturally" had cholesterol in the 150-160 range and was sick his whole life.  

IMHO that womans cholesterol is doing what it does to save her life.  Rising to wrangle up the garbage she's dumping down her throat.  

My fathers never rose to combat the garbage he was dumping down his throat.  What are your thoughts on that?

If this stuff happens as you say, a fairly simple pattern, then why the differences?

Dr. Davis - This is off topic for this particular post, but I want to suggest the next blog post for you.  

First, cudos for keeping this blog informational only, without a hint of commercialism in in.  However, I and perhaps others who read it have seriously considered contacting your office for an appointment to become patients, even though we live in other parts of the country.

Would you consider posting a topic on the blog of how this could work?  My thoughts are to have necessary tests done in advance of a visit, so that things which normally take 2-3 visits could be accomplished in one. Is a list of these things something that could be determined by a phone interview with your office staff when the appointment is being made?  Can your office arrange for heart scans to be done in Milwaukee in the AM for a PM appointment with you?

Important question: Is a heart scan at a closer facility (Still 3 hours away) & track your plaque membership (not yet done because I've not had a scan yet) just as good as a visit to your office once a year or would I get additional benefits becoming a patient? i.e., can you rely on scan scoring done by others if I wanted your opinion on the results?

Two other things all those carbs will do to susceptible people is give them bloating and acid reflux. The posts on that subject have been my two most popular over the past month.

Re: cholesterol, mine is 140. The total didn't change much when I cut way back on the carbs, but the ratio of HDL:LDL improved. If I'm sick or riddled with cancer, I'm afraid it's escaped my notice. My liver must be making all I need.

I don't miss the cookies, overly sweet eggnog, and Christmas candy at all, since I revised my diet in early 2004.  I don't gain holiday weight anymore; in fact, some years I lose a couple pounds between Thanksgiving and New Years.

When I celebrate during the holidays with food, I do indulge (if you can call it, that because my indulgences tend to be nutrient-dense and very satisfying, too) with rich paté, lovely artisan cheeses, fish roe (caviar) and deviled eggs, fresh veggie slices, and bacon-wrapped scallops and shrimp, etc.  I make egg nog that isn't nearly so sweet as well as super easy homemade truffles with very dark chocolate, which has just a small amount of sugar.

I eat a high carb diet (60% typically, lots of oats, beans, potatoes) and just got back my first test result:

Cholesterol, Total   152
Triglycerides         39
HDL Cholesterol       70
VLDL Cholesterol calc  8
LDL Cholesterol calc  74

I'm lean (16% body fat according to my electronic scale, 12% according to a formula I found on the internet) and get plenty of moderate exercise (yoga and walking). So it appears all those carbs are NOT turning to Triglycerides in me.

Rather, when I eat carbs, the glucose goes into the muscles. After I finish my last meal for for the day, the body gradually burns off this stored glucose so that the muscles are mostly depleted by the next morning, when I break my nightly fast. Isn't this how the body is supposed to work? I have to disagree with this notion that the muscles can only store a couple of hundred grams of glucose. I think that amount of glucose that can be stored increases in lean people who exercise and routinely eat large amounts of carbs.

Brent, You have been reading my mind! Yes, Dr Davis please tell us how best this could best be accomplished as per Brent's comment!

I've been looking more into de novo lipogenesis. The key conclusion I see is the following:

Hepatic de novo lipogenesis in normoinsulinemic and hyperinsulinemic subjects consuming high-fat, low-carbohydrate and low-fat, high-carbohydrate isoenergetic diets by Jean-Marc Schwarz, Peter Linfoot, Doris Dare, and Karmen Aghajanian (2003)

...
In the present study, this higher proportion of simple sugars (54%) led to elevated fractional hepatic DNL, whereas when only 40% of the carbohydrate consisted of simple sugars, hepatic DNL was minimal (11). Overall, these findings confirm and extend previous results from Hudgins et al (8), who found that the proportion of simple sugars in very-low-fat, high-
carbohydrate diets was the determining factor for hepatic DNL in healthy subjects.

In other words, if you are healthy to begin with (lean and exercise daily) AND you eat mostly complex carbs AND you don't overeat, then de novo lipogenesis is NOT a problem.

Bit over simplified; unless holiday indulgences (prior to patient's Jan. lab test) were made rich tasting without using any fat &/or cholesterol content
(and wasn't over eating, nor lazing around).

Clinic patients are presumably often already suffering with metabolic syndrome. An absolute admonishment is going to become rote patient visit after patient visit.

Is a prevention strategy for everyone, or just the sedentary and geneticly pre-disposed? One's adult health may be doing well with a contrary diet. By middle age Doc's restrictions might be a pre-emptive strategy for countering metabolic changes to come.

So if Jeanne returns to restricting sugar and flour from her diet in January, her profile improves.  Did she leave lasting damage?  Is the risk only that disease will develop during her holiday relapse?

Anna--

I love the gourmet-bent you've taken with your diet. That's a great direction to go.


Brent and Michael--

You can call my office at 414-456-1123 to arrange an out-of-town visit. Alternatively, call the same number to arrange a video teleconference to review lipoproteins or your coronary prevention program. (Video teleconference is not covered by insurance, however.)

I treat so much cholesterol in my patients with bio-identical hormone therapy in addition to nutritional biochemistry / blood test to help rebuild the adrenals and help the body convert the excess cholesterol into the LDL and then into the next hormone called pregnenolone. Most people who have high cholesterol have silent adrenal dysfunctions/ burn out / PTSD whereby the cholesterol does'nt convert into the next hormone.
Most MD's won't look to check the adrenal and sex hormones in conjunction with and cholesterol test.
What an oversight eh !

I used to have very lows trigs (35-45 range), I start eating high fat low carb & 6 month later my trig went up to 79.

Carbs = elevated trigs??
Not for me.

  My lowest trigs were in my vegetarian days eating whole wheat, oats, beans etc...when I started upping the fats & meat my trigs went up (even when cutting down wheat, which I dont eat it anymore)

Could you provide an answer to this mr Davis?

I agree that holidays is a season to increase weight gain. Uncontrollable eating can risk our health. There is no any guarantee how long can our body take the cholesterol we're feeding. So proper self-discipline is needed. Low carbohydrate diet is the best diet for those who want to lose weight especially for diabetic people.

You forgot agave syrup, which a lot of people are using as an "all natural" low-glycemic replacement for HFCS. In fact, it contains more fructose than HFCS.

One manufacturer's products include “low glycemic monosacharide.” Gosh, I wonder what that is.

It would be a service, if you (or someone) posted a "fructose" content list which includes all the common fruits and berries. I eat a lot of berries and have wondered if that is such a good idea. A list would help us define "good calories" regarding these possible fructose bombs.

Thanks for the visuals and labels on fructose...I am very aware of fructose contents and fruit -- especially since I have experience with fruit and gout attacks that may or may not be supported in literature.  I will only add that every time you purchase a product DO NOT ASSUME CONTENTS ARE THE SAME as when you last purchased.  For example, Classico pasta sauces which I used as base for soups and stews (all LC) has started adding sugar.  CostCo Kirkland brand marinated artichoke hearts (again LC) started out using olive oil, now uses cannola oil. My experience as label-reading shopper is food producers are now adding sugars including fructose to just about everything because the buying public perceives sugar to be tastier...even the rotisserie chickens most grocery delis have now...be careful if you very LC to whether the spice rub has sugar in it.

What don't you find it in?

Finding it hard to believe that an apple wouldn't have some other redeeming value that counteracts or balances the fructose content: soluble fiber, fiber, vitamins, minerals, etc.  Hopefully this is not an indictment of all fresh fruits?

It's all very well to measure fructose content, but it is meaningless unless we know what intake levels have to be before they become problematic.

In my own case, when I went "paleo" a couple of years ago, I swore off sugar, grain, and processed foods.  I lost 15 lbs over six months without trying.  Now this was before I heard about the fructose issue, and I was eating fruit like I never had before in my life, 3 to 4 pieces a day, and the sweet ones, too:  apples, bananas, grapes, dates, etc.  Surely I was ingesting more fructose than I had been before with a blob of ketchup here, steak sauce there...

Not to put too fine a point on it, but what you show as A.1. Steak Sauce is actually their marinade. Real A.1. Steak Sauce (at least my bottle) contains no HFCS, but does have 2g sugar per serving. Thank you for spending the time you do on this blog; you, along with some others, have given me the intellectual and scientific basis I needed to change my diet. The improvements, physical and mental, have been astounding.

The fructose info is interesting, but I agree with GK. We really need to know what is considered a safe level before condemning all fructose sources.

Fruits do have certain health benefits, some more than others, especially berries. There is also the possibility that by becoming super fructose-phobic and avoiding all fruits/berries,  that one could decrease their chances of heart disease, just to succumb to cancer instead.

Perkdoug, I have found that the web site "nutrition data" has a breakdown of sugars for things. Go to nutritiondata.com and type in the food you are interested in. Choose the right food and quantity and then go down to the section on carbohydrate and click the see more details. When I did that for dates, 1 medjool has about 7.6 grams of fructose (eek!). Like many folks I am cutting down on my fructose consumption so use this table a lot.

How about the king of HFCS--Soft drinks and candy.

As someone else asked, "what don't you find it in?"

Fructose can be found in many vegetables too.  One sweet onion has 6.69 grams, a half head of cabbage has 6.58 grams, a head of lettuce has 5 grams, a cup of chopped red peppers has 3.37 grams, a medium sized cucumber has 2.62 grams.  In fact nutritiondata.com lists 138 vegetables which have some amount of fructose in them (albeit many having very small amounts.)

So, if one's goal is to avoid all sources of fructose and still maintain any semblance of good health, well good luck.

@Nameless: Well put!

I think tossing fruit is a bit of the baby out with the bathwater.Fruit has the most wonderful spectrum of bright tastes and flavors of any food we have on the planet. "Healthy" vegetables encompassed the bitter, the flat, and the algae like part of the flavor spectrum. Me, is meet and nice in small to medium quantities but when eaten in low-carb volumes, it just becomes something you shovel in to make hunger go way.

Fruit is a wonderful gift. Adding a little sugar and heating some berries produces this wonderful sauce you can pour over pancakes or creps (if my diabetes let me have crepes). Some fat, flour, and salt makes a wonderful crust that you wrap around sliced and spiced fruit. Cold cherries crunch between your teeth dribble juice around your tongue while you roll the stone around your mouth cleaning off the last of the fruit meat. Peaches with ginger, peach blackberry, blueberry pie. Sliced and cored apples cooked in red-hot cinnamon sauce on the stove and then chilled before serving on Christmas Eve. On a hot August day, wandering through an orchard and dodging Yellowjackets when picking a beautifully ripe peach off the tree.  Pulling a crisp apple out of winter store in November and tasting what will become cider.

On a more practical level, I also need to make the decision on how much fruit versus how much bulk  laxative? If I eat one piece every days, I'm looking 8+ tablespoons of Metamucil.  bleck.  I'd rather starve myself in  other areas to make room for the delightful sweetness of fruit.

Who said throw fruit out?

I believe you are reading things that aren't there.

I disagree.  without giving a threshold of "bad", your presentation implies that all fructose at any level is bad.  I read some comments as expressing fear or doubt that they were eating too much fruit.  others like me what to know the threshold of bad.

just between you and me, I'd give up living before I gave up fruit.  no joke.  the flavours of fruit are that important to me.  I've already lost enough food ground with diabetes, I'm not giving up any more.

According to Dr. Richard Bernstein, fruit does not have to be a part of a healthy diet. Here is what he says in his book, Diabetes Solution:

"Although eliminating fruit and fruit juices from the diet can initially be a big sacrifice for many of my patients, they usually get use to this rapidly, and they appreciate the effect upon blood sugar control. I haven't eaten fruit in almost forty years and I haven't suffered in any respect. Some people fear that they will lose important nutrients by eliminating fruit, but that shouldn't be a worry. Nutrients found in fruits are also present in the vegetables you can safely eat."

Dr. Bernstein has had T1DM for about 50 years and advocates a very low carb diet to help normalize blood sugars. http://www.diabetes-book.com/

Because of blood sugar problems I have eliminated all sources of HFCS and have greatly limited my fruits. I find I can eat a few berries or a bite or two of other fruits without raising my blood glucose, but I mostly stick with colorful low carb veges.

Dr: Davis -- "Who said throw fruit out? I believe you are reading things that aren't there."

Yet you start this post with a photo of an apple. Although perhaps it wasn't  your intention, it certainly implies that fruit is bad.

National estimates of dietary fructose intake increased from 1977 to 2004 in the United States.
high-fructose corn syrup percentage of sweeteners increased from 16% in 1978 to 42% in 1998
Since 1978, mean daily intakes of added and total fructose increased in all gender and age groups, whereas naturally occurring fructose intake decreased or remained constant.
If you can't get the full text at least read the abstract. The full text has some interesting charts presenting the data more clearly.
It isn't eating naturally sourced fructose from whole fruit driving increased obesity. Increases in fruit consumption are dwarfed by greater increases in total daily energy and carbohydrate intakes.

RE: Comment by Nameless (“Yet you start this post with a photo of an apple. Although perhaps it wasn't your intention, it certainly implies that fruit is bad”)
-------------------------------------------------------------------------------------------

The good doctor is merely demonstrating in effective graphic terms that
too much of a good thing is not good. The numbers (ie gms of fructose)
are important guidelines. There’s no point in getting your nuts in wringer over it!

Bernstein developed Diabetes at age 12. He was born in 1934, so at age 75, he has been diabetic for 63 years. No diabetic complications. Normal blood sugar for all!!

I think its more helpful to express sugar content (and fructose if known) as a percentage rather than an amount per (varying) serve.  It makes it easier to compare apples to apples (scuse pun).  I've prepared a few listings of various food groups (several hundred items in each) on this basis at www.howmuchsugar.com if you are interested.

Some people suffer from fructose malabsorption. One source states that it is found in approximately 30-40% of the population of Central Europe. If one has that condition, then it would be prudent to avoid all fructose, even the fructose found in fruit. I love the taste of fruit, but it is destroying my health due to malabsorption issues. Fortunately, we know that some cultures lived very healthy lives without eating fruit (e.g. Eskimos).

I don't get it. What am I not seeing?

How much high fructose corn syrup is in a serving of the BBQ sauce? How much in a serving of the steak marinade?

You state such figures for a serving of apple (1 medium), and for a serving of honey (2 Tablespoons).

I had to give up fruit to prevent further beta cell damage (above 140 apparently for pre-diabetics, and maybe everyone, I don't know). Fruit and many veggies are toxic to people with glucose intolerance. I had to give up veggies for now, until I can find one that I can tolerate. Cabbage was too hard on my blood sugar. I am slowly trying to figure out what I can eat and how to minimize the glycemic impact. Unfortunately, I might have to damage my beta cells to find out what works. The system told me I was fine, even though I told them I had sugar problems. I gave up on doctors 10 years ago, since they were useless. I finally bought a meter and started testing, and the truth is painful.

In addition, since I have been involved with cardiac CT for now nearly 24 years, the PLC also affords me an opportunity to develop a CT coronary angiography training program for cardiologists and radiologists (www.cardiaccta.us). Together, these new efforts are merely an extension of my interests in prevention, patient care, and teaching.

My father was working in Detroit in 1980 and 81, arguably the center of America's anti Japanese car hatred at the time.  I can remember when he came home he would tell stories of the destruction of Japanese cars that auto workers did.  If you drove a Japanese car in Detroit at that time, I got the impression  that there was an excellent chance the auto would be crashed into on purpose while sitting at a stop light or someone at night possibly might take a sledge hammer to the hood or windshield.

Many people have a hard time handling change. What happened with Americas auto employee's rage over competition from Japanese car isn't much different than you see in the stock market, I believe.  People have a tendency to believe something will last forever.  They don't want to believe that events tend to occur in cycles.  Even when all evidence seems to point toward an event happening, they  find reasons to ignore it, and later act in disbelief when it occurs.        

Times have been good for many health care professionals.  But the writing seems to be on the wall that change is coming.  Hopefully, I am guessing it will, inexpensive heart disease prevention will play a larger role in the future.  The results prevention bring are too good to ignore.